Comparable effect of conventional ventilation versus early high-frequency oscillation on serum CC16 and IL-6 levels in preterm neonates

Abstract

Objective: Clara cell 16 kD protein (CC16) and interleukin (IL)-6 have been used as peripheral blood biomarkers of alveolar leakage and inflammation, respectively. Thus, their measurement in the bloodstream could be used to assess ventilator-induced lung injury. The objective of this study was to evaluate the effect of optimized synchronized intermittent mandatory ventilation (SIMV) and high-frequency oscillatory ventilation (HFOV) on circulating CC16 and IL-6 levels when used as the initial ventilation modes in preterm neonates.Study Design: Single center, prospective, randomized clinical study in preterm neonates (gestational age p30 weeks) requiring mechanical ventilation within the first 2 h of life. Serum CC16 and IL-6 were measured on establishment of the assigned ventilation mode after admission, at days 3 and 14 of life as well as at 36 weeks postmenstrual age. Demographicperinatal data and clinical parameters were also recorded.Result: Of the 30 neonates studied, 24 (gestational age 27.1 ± 1.7 weeks, birth weight 942±214 g) were finally analyzed, equally assigned into the SIMV and HFOV groups. Both groups had comparable demographicperinatal characteristics and clinical parameters. Serum CC16 and IL-6 altered significantly over time (repeated-measures analysis of variance, both P<0.001). However, changes were not affected by the ventilation mode. Post hoc analysis showed a significant decrease in CC16 and IL-6 from birth up to 36 weeks postmenstrual age in both groups. Conclusion:In preterm neonates, SIMV and HFOV are associated with comparable circulating CC16 and IL-6 levels. These findings suggest a similar alveolar leakage and systemic inflammation with any of the ventilation modes evaluated when their usage is optimized.

Renal dysfunction decreases specificity and overturns cutoff value of serum CC16 while prohibiting 7-day mortality prediction in diagnosing acute respiratory distress syndrome in intensive care unit.

“…Although previous studies have revealed a relatively stable median CC16 level in normal controls (5-7 ng/ml), the median CC16 value of critical care patients in our control group appeared to be higher (22.23 ± 13.28 ng/ml), probably because clinical conditions such as mechanical ventilation or primary graft dysfunction might promote the production of CC16 [28,29]. This could have led to an unavoidable selection bias.…”

A comparison of high-frequency jet ventilation and synchronised intermittent mandatory ventilation in preterm lambs

“…[26][27][28][29] Comparisons of lung injury following HFOVand CV vary. Various reports indicate either (1) little difference in the alveolar leakage and systemic inflammation in neonates, 30 (2) attenuation of early activation of inflammation and clotting in preterm lambs during HFOV when compared to CV 31 and (3) reduced pro-inflammatory cytokines in HFOV treated neonates compared to CV. 32 There are fewer studies comparing lung injury during HFJV to other ventilator modalities, but a comparison of HFJV and HFOV in rabbits showed a clear reduction in lung injury following HFJV.…”

Systemic inflammation associated with mechanical ventilation among extremely preterm infants

“…The studies of very preterm newborns, which have also documented systemic inflammation associated with ventilation, have been limited in the number of subjects and the number of indicators of inflammation [9-13]. …”